Page 337 - Cote clinical veterinary advisor dogs and cats 4th

142 Calicivirus, Feline

ASSOCIATED DISORDERS compounds); persists ≥ 1 month in cool • Thoracic radiographs: usually unremarkable;
dry environment
• Chronic ulceroproliferative and lymphoplas- • Incubation 2-10 days, replication in the pneumonia/pulmonary edema in severe
VetBooks.ir • Faucitis oropharynx. VS-FCV tissue tropism may TREATMENT
disease
macytic stomatitis
• Ulcerative glossitis
be wider than for non-VS-FCV.
• Pyrexia
• Lameness (transient) • Shedding occurs primarily during acute Treatment Overview
disease but may persist up to years after
• Systemic illness (see VS-FCV entries) recovery. Some cats are lifelong shedders. Treat as outpatient wherever possible to prevent
• Implicated in feline lower urinary tract disease • Prevalence is proportional to the number nosocomial infection. Supportive care is suf-
and enteritis (role not well established) of cohabitating cats (10% in single-cat ficient for most patients with mild to moderate
• Respiratory distress (rare) households, 40% in shelters, 90% in some disease. Outbreaks usually resolve by 2 months
• Other respiratory pathogens (p. 1006) colonies) with appropriate control measures.
• VS-FVC: disease is sporadically reported in
Clinical Presentation the United States and Europe. Acute General Treatment
DISEASE FORMS/SUBTYPES • Acute oral/respiratory tract disease: symp-
• Subclinical infection DIAGNOSIS tomatic and supportive care (rehydration,
• Acute oral/respiratory tract disease pain management, nutritional support (e.g.,
• Chronic stomatitis Diagnostic Overview appetite stimulants), clear nasal secretions,
○ FCV isolated from most cats with chronic Often a clinical diagnosis without confirmatory nebulization)
ulceroproliferative and lymphoplasmacytic testing. Specific positive tests for FCV infection ○ Syringe feeding is not recommended to
stomatitis should be interpreted in light of presentation avoid food aversion.
• Limping syndrome because the carrier state is common. ○ Treat corneal ulceration if present (p. 209).
• VS-FCV (rare but occurs in outbreaks) ○ Buprenorphine 0.01-0.03 mg/kg q 8-12h
Differential Diagnosis IM, IV, PO if analgesia warranted
HISTORY, CHIEF COMPLAINT • Other upper respiratory pathogens (p. • Limping syndrome: usually self-limited, but
History and clinical signs depends on infect- 1006) analgesia should be considered
ing strain, age, and disease form. Common • Corneal injury/trauma • VS-FCV: aggressive supportive care, antibiot-
complaints: • Caustic chemical exposure (e.g., liquid ics, consider antiviral therapy
• Inappetence/anorexia potpourri, acids or alkali) ○ Extremely contagious; strict isolation with
• Ocular/nasal discharge • Electrical burns barrier protection vital
• Sneezing • Periodontal disease ○ Judicious use of fluids due to edema
• Drooling • Eosinophilic granuloma ○ Address organ dysfunction, coagulopathy
• Halitosis • Oral ulcers (p. 1002) ○ Antivirals: feline interferon omega inhibits
• Lameness replication of FCV in vitro. In vivo studies
Initial Database are lacking. Most veterinary antivirals
PHYSICAL EXAM FINDINGS • Oral examination: identify ulcerations, inhibit replication of DNA or retroviruses.
• Subclinical infection: none proliferative changes, periodontal disease
• Acute oral/respiratory tract disease: acute • Feline leukemia (FeLV) and feline immuno- Chronic Treatment
onset of sneezing, serous nasal discharge, deficiency virus (FIV) testing (note: maternal • Relapses are uncommon, although re-infection
oral ulcers, epiphora, blepharospasm, fever, immunity can cause false-positive FIV test with new disease subtypes is possible.
inappetence, ± ptyalism result in kittens < 6 months) • Chronic stomatitis (p. 943): Clinical trials
• Chronic stomatitis: ulcerative or proliferative • Ocular fluorescein staining are lacking. Potentially, antibiotics, dental
faucitis/stomatitis • CBC/serum biochemical profile/urinalysis prophylaxis, glucocorticoids ± immuno-
• Limping syndrome: transient fever and lame- (not routinely performed): unremarkable modulatory drugs, whole mouth extractions,
ness, typically follows acute oral/respiratory ○ In cases of pneumonia and VS-FCV: interferon omega (systemic/intralesional)
disease or vaccination with modified live inflammatory leukogram, thrombocyto-
FCV vaccine penia, anemia, and changes consistent with Nutrition/Diet
• VS-FCV: severe acute oral/upper respira- multiple organ dysfunction Feeding tubes may be required for patients with
tory signs (see above), fever (often > protracted anorexia or chronic stomatitis (pp.
105°F), cutaneous edema (head and limbs), Advanced or Confirmatory Testing 1106 and 1107).
cutaneous ulcerations (nose, lips, footpads, Viral identification usually only necessary for
ears, periocular), icterus (hepatic necrosis, epidemiologic purposes (e.g., shelter or cattery Drug Interactions
pancreatitis), respiratory distress (pulmonary outbreak) Avoid combining nonsteroidal antiinflammatory
edema [pp. 836 and 879]), petechial or • Virus and antigen detection drugs and glucocorticoids.
ecchymotic hemorrhage (from disseminated ○ Reverse transcription polymerase chain reac-
intravascular coagulation) tion (RT-PCR): conjunctival/oropharyngeal Possible Complications
swabs: false-negatives due to varied viral • Hepatic lipidosis (prolonged anorexia)
Etiology and Pathophysiology genome, markers for VS-FCV unavailable • Viral or secondary bacterial pneumonia
• Highly variable and rapidly evolving ○ Viral isolation: conjunctival, nasal, oro- (p. 795)
single-stranded RNA virus with multiple pharyngeal swabs, less sensitive to virus • Death from VS-FCV or severe disease
subtypes variability than RT-PCR. False-negatives
○ Single serotype despite antigenic variability due to low viral burden and viral deac- Recommended Monitoring
• Transmission: oral and nasal secretions by tivation. Collecting conjunctiva and Clinical signs
fomites or direct contact; aerosol transmission oropharyngeal swabs may maximize yield.
(minor) • Antibody detection: ELISA PROGNOSIS & OUTCOME
○ Non-enveloped virus; resistant to environ- ○ Prevalence is high due to frequent natural
mental stressors (e.g., light, temperature) and infection and vaccination. • Good for acute oral/respiratory tract disease
disinfectants (e.g., quaternary ammonium ○ Not clinically useful for diagnosis and limping syndrome

www.ExpertConsult.com